Objectives Vulvar squamous cell carcinoma (vSCC) is a gynecologic malignancy diagnosed in nearly 4500 women in the U.S. each year. Current criteria for treatment planning provide inadequate assessment of aggressive vSCC cases, resulting in insufficient use of adjuvant treatments and high rates of vSCC recurrence. Perineural invasion (PNI) is a pathologic feature inconsistently included in the assessment of vSCC because its relevance to clinical outcomes in these women is not well defined. The purpose of this study was to determine the association between PNI and relevant clinical parameters such as recurrence. Methods 103 cases of vSCC were evaluated for PNI using pathology report review and IHC dual-chromogen staining for S-100 and AE1/3. Medical records were reviewed for clinical and follow-up data. Data were analyzed using univariate and multivariate logistic regression statistical methods. Results Patients with vSCC containing PNI had a greater risk of cancer recurrence than those whose tumors did not contain PNI (OR = 2.8, p = 0.0290). There was no significant correlation between the presence of PNI and nodal involvement, stage, or lymph-vascular invasion (LVI). Tumors with PNI had greater depth of invasion (DOI) (p = 0.0047), however DOI was not associated with recurrence (p = 0.2220). When analyzed using a multivariable logistic regression model, PNI was an independent predictor of recurrence in vSCC (adjOR = 2.613, p = 0.045). Conclusions Perineural invasion is an independent indicator of risk for recurrence in vSCC. The association of PNI with increased risk for recurrence, independent of DOI, nodal involvement, LVI, or stage, should encourage practicing pathologists to thoroughly search for and report the presence of PNI in vSCC.

Obese women who developed endometrial cancer while on metformin did not seem to have pathologic risk factors different from those not on metformin. However, the type I cancer patients on metformin were less likely to recur than those not on the drug. This suggests that a prospective trial of metformin at the time of diagnosis of endometrial cancer in the obese population may be warranted.

Most of the participants in this study were not aware of the CAP guidelines. The study also revealed deficits in understanding the nomenclature on pathology reports even though providers overall recognized the clinical utility of pathologic examination of the placenta. This emphasizes the importance of actively incorporating the concept of pathologic changes of the placenta into the curriculum for training obstetrician gynecologists and pathologists and for institutions to streamline policies centered on pathologic examination of the placenta.

Patterns of invasion and stromal response are understudied in vulvar squamous cell carcinoma (vSCC). The aim of this study was to explore whether histologic features such as an infiltrative pattern of invasion and fibromyxoid stromal response (FMX-SR) are meaningful prognostic factors. We reviewed 143 vSCC resections and correlated patterns of invasion and stromal response with patient age, ethnicity, depth of invasion (DOI), tumor size, perineural invasion (PNI) (S100/AE1/3 stain), lymph node involvement (LNI), extranodal extension, margin status, pathologic stage, and recurrence. Univariate analyses of continuous variables were performed using t-tests, while Pearson’s χ2 tests were used for categorical variables. Logistic regression analyses examined the relationship between histopathologic characteristics and clinical outcomes. There was a statistically significant association between infiltrative tumors and a FMX-SR in comparison to non-infiltrative tumors (p < 0.001). Tumors with FMX-SR were significantly more deeply invasive (p=0.0025) and more likely to have LNI (p=0.0364), extranodal extension (p=0.0227) and PNI (p=0.0011) compared to tumors without FMX-SR. For cases with negative surgical margins, the association between tumors with FMX-SR and LNI was significantly strengthened (OR=4.73, p=0.0042), even after adjustments for age, race and DOI (OR=4.34, p=0.0154). Presence of both FMX-SR and infiltrative pattern of invasion in tumors with negative margins was significantly associated with LNI (p=0.0235) and recurrence (p=0.0124). These results suggest that interactions between nerve, tumor, and stromal cells play a role in tumor progression and represent additional prognostic factors that help stratify those patients at highest risk for LNI, extranodal extension and recurrence.

Background: Information about the diagnosis and management of late abdominal pregnancies (≥20 weeks gestation) is limited to case reports and small case series. Methods: We performed a literature review of abdominal pregnancies ≥20 weeks gestation from 1965 to November 2012. Excluded were abdominal ectopic pregnancies that did not primarily implant in the peritoneal cavity, including tubal, ovarian, and intraligamentary pregnancies, and those prior to 20 weeks gestation. Results: The 31 cases identified were at 30.4 ± 7.4 weeks at diagnosis and 33 ± 8.3 weeks at delivery. The most common sites of placental implantation were uterus or adnexa (47.8%), bowel (30%), and the potential spaces surrounding the uterus (8.7%). There were 5 cases of an intra-abdominal abscess in the 14 patients in whom the placenta had been left in situ. Maternal outcomes were documented in 26 cases with 7 deaths; 27 fetal outcomes were documented in 22 cases with 3 fetal deaths (13.6%). Conclusion: An abdominal ectopic pregnancy is an uncommon but serious event and should be considered in all patients until intrauterine gestation is confirmed. Management should be undertaken by an experienced surgical team in a tertiary care facility.